What’s on your mind?Guidance for Seafarer’s Mental Health Awareness

May 2019

Mental health matters

Mental wellness, while often overlooked, is an important aspect of the health and wellbeing of the crew aboard a ship. Accidents or incidents resulting from a seafarer’s mental breakdown will have significant consequences for the company and ship’s crew. In the seagoing community an understanding and engagement in matters of mental health is vital. In this guidance, we will review some of the common risk factors of a developing mental health condition and recommend measures to prevent or treat an occurrence onboard. Recognizing the developing symptoms, or early warning signs, can and will make a difference.

Not all wounds are visible

There are many different conditions that are recognized as mental illness(es). Some of the more common types include:

• Anxiety - intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (e.g. panic attacks).

• Depression - a mood disorder that causes a persistent feeling of sadness and loss of interest.

• Eating disorders - involve extreme emotions, attitudes, and behaviors involving weight and food, commonly taking form as anorexia, bulimia, or binge eating.

• Impulse control and addiction disorders - People with impulse control disorders are unable to resist urges or impulses to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), drug/alcohol abuse, or compulsive gambling are examples of impulse control disorders.

• Post-traumatic stress disorder (PTSD) - people with PTSD often have lasting and frightening thoughts after experiencing a terrifying or traumatic event such as sexual assault, death of a loved one, or disaster.

• Obsessive compulsive disorder (OCD) - a constant fear that compels a person to perform rituals or “compulsions”.

• Common stress - leading to erratic or unpredictable actions.

While all of them are different, without effective treatment for the ailing seafarer, these illnesses could result (and have resulted) in serious consequences for the ship and its operation.

A sign that something is wrong

Situational mental illness unlike the more severe and diagnosed illnesses can result from circumstance or increased stress. Stress can have mental, physical, emotional, and behavioral effects on a person. You may recognize small changes in an individual or feel that “something is just not right.”

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Some detectable manifestations include:

These symptoms may cause difficulty with completing tasks and duties aboard ship and should be a sign to a ship’s master its officers and senior crew that a crewmember is in distress. Early intervention can help prevent an illness from worsening.

Watch out for stressors onboard

There are many contributors that can impact the mental wellbeing of a seafarer, some obvious and some seemingly benign, but harmful nonetheless. Seafarers may be more likely to suffer from mental health issues as opposed to those working on land due to a number of environmental “stressors” such as:

1. Seclusion from the outside world: from the confines of living on the vessel and having limited contact with family.

2. Monotony of work duties: modernization and automation of certain functions aboard ships has increased monotony for seafarers.

3. Possible addiction to alcohol and/or drug: there is a connection between mental illness and substance abuse and the symptoms of one disorder can trigger the other. The substance abuse may be an attempt to self-medicate, however mental illness is usually worsened by substance abuse.

4. Social Isolation: 76% of seafarers reported to have never or rarely gone ashore while on board, which 2

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can contribute to mental health symptoms associated with social isolation. Causes of social isolation include reduced crews, lack of social cohesion aboard, time spent away from home (a very frequent cause of loneliness and social isolation) fatigue, harassment and bullying, and limited shore leave.

5. Language Barrier: the employment of multinational crews aboard ships leads to a lack of social cohesion and a difficulty for seafarers to communicate with each other. The added language barrier for multinational crews makes it more difficult for communication and may lead to crewmembers becoming more isolated from each other.

6. Bullying: almost 50% of seafarers experience bullying and harassment while at sea. Bullying is often called psychological harassment or violence. These attacks destabilize and disassemble the target’s identity, ego strength, and ability to rebound from the assaults. The longer the exposure to stressors, like bullying, the more severe the psychological impact.

7. Medical Causes: while not a stressor on its own, a diagnosed disorder if combined with an environmental threat could expose a mental illness. Some mental conditions have been linked to an abnormal balance of brain chemicals called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or are not working properly, messages may not make it through the brain correctly, leading to symptoms of mental illness. There are also hereditary connections for mental illness which are passed on from parents to children through genes. The seafarer may have a relative who has been diagnosed with a mental disorder in their family’s medical history, making them more likely to develop a condition than if they do not have an affected family member. In even less cases a mental illness can be the result of a physical brain injury or trauma.

The consequences: mental health affects everyone

In addition to the adverse personal health impacts on crews, mental health already costs shipowners financially and will continue to do so until appropriate guidelines and precautions are established to prevent suicides and other unfortunate outcomes of bad mental health among seafarers.

In 2011, delays and diversions related to crew member suicides cost between $50,000 and $100,000 on average. In terms of the general population, mental illness costs the United States $192 billion in lost earnings a year. Suicide is the 10th leading cause of death in the United States and costs the United States $51 billion annually. Men die by suicide 3.5 times more than women do on average. Currently the majority of seafarers are male increasing the risk profile for the maritime industry in comparison to many other global industries.

A mentally healthy workplace

Not only is it important for seafarers in need of support to have access to adequate mental health information and resources, but it just as important to provide the necessary tools and suitable environment for all seafarers to maintain their own positive mental health while onboard.

Shipowners who take a proactive approach in providing access to basic mental health resources and making the routines of life at sea more bearable will be more likely to prevent loss of life and harmful

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conditions for all crew aboard ship.

Morale: A positive and professional work environment is guaranteed to result in high employee morale and performance. There are many simple ways to promote morale among seafarers onboard a vessel and it can be as simple as remembering and celebrating a shipmate’s birthday or big events, or having a good cook onboard for the voyage.

A crew that is well trained and aware of their duties and responsibilities will take pride in its work and have a better sense of fulfillment. Offering the crew recognition or incentives for a job well done is also a great motivator. If there is one person who is resistant or disruptive to workplace morale, removing this person should be considered.

Better connectivity with the internet has its advantages and disadvantages, including contact with family and friends ashore. Reduced crew numbers onboard ship make connectivity a more important tool for social interactions because there are less people onboard to physically interact with regularly. A lack of social cohesion aboard ship contributes heavily to these unhealthy mental states, which is why members are advised to counteract this. A social or non- social ship environment is key to the success of implementing positive mental health initiatives aboard a vessel.

Constant social media use in the general population has been shown to increase depression for individuals at risk for depression. The same conclusions apply to seafarers, who are completely cut off from a world they can only glimpse through Facebook updates and Instagram likes. The positive side of internet connectivity is increased contact with loved ones and family back home. However, there are potential problems with stress related to family and shore-side life that seafarers learn about through

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social media.

If technology can be utilized in the day-to-day life of seafarers that is beneficial to their mental health and detracts from the more difficult aspects of life at sea, then it is something for members to consider implementing. According to a recent ISWAN technology study, 40% of older seafarers felt that social media use had a reduced impact on social interaction on board. 16% felt that it impacted crew communications. However, this is a reduction from 22% in 2014, showing that as social media use onboard ship continues, crewmembers are more accustomed to it and use it for social interaction rather than isolation.

Stress Relievers: Other ways to cope with stress at work onboard include many alternatives to use of technology and social media. Meditation and mindfulness exercises, physical exercise, and proper rest during off hours are essential to a healthy crew population aboard ship. Links with professional advice on the subject include www.seafarershealth.org with the International Seafarers Welfare and Assistance Network.

Proper Rest: Ensuring proper rest for crewmembers is essential for warding off fatigue that can exacerbate mental health risks to seafarers and influence other potential safety factors aboard ship . Anxiety and depression often occur in moderate forms for individuals under intense amounts of stress without proper outlets to relieve it.

The suggestions above are not exclusive or limited to the kinds of prevention and mental health coping strategies that are available for seafarers. Members are advised to be aware of these strategies to prevent an incident from occurring on their vessels. Proper mental health at sea could be the difference between a delayed vessel and timely prompt vessel.

Eliminate alcohol and drug misuse

Alcohol is a natural depressant which can exacerbate and worsen bad states of mental health. Drinking alcohol may have a temporary positive effect on mood, but that is short lived after continued exposure. Consumption and possession of drugs and other abused substances is strictly prohibited on all ships. The company’s Alcohol Policy and code of conduct must be adhered to and carefully considered in all mental health cases.

Mental health is not a choice, but recovery is!

Onboard Care: It is up to the Master’s discretion to determine if a crewmember needs to be monitored to ensure their own wellbeing and the safety of the ship and other crewmembers. Always consult the opinion of the doctor or medically qualified person if onboard, or a medical advice call-in service. Crewmembers who have expressed symptoms of anxiety, depression, or a more severe illness should be monitored and/or have their duties curtailed to a minimum until a medical professional has treated them. Crewmembers with a mental illness may pose a risk to themselves and the rest of the crew with whom who they work with. It is important to develop a monitoring protocol that protects seafarers during these times while waiting for proper medical treatment. Every situation will require different strategies and details so you may consider seeking advice on a contingency plan and documenting any preventative actions taken.

Professional Treatment: When diagnosed early and treated properly, many people fully recover from their mental illness or are able to successfully control their symptoms. Statistics show 8 in 10 people suffering from a mental illness can effectively return to their normal activities if they receive appropriate treatment. Treatment which goes beyond the normal care that can be provided onboard may require some encouragement.

Care for your mind and care for your shipmates

Social isolation and the difficulties of working at sea take their toll on the human psyche unlike other professions. However mental health is not an exclusive problem to the shipping industry. It is a global concern with potentially devastating consequences. Because of recent advances and increased awareness to this issue, seafarers now have more alternatives for proper access to mental health care if they seek it out. Members should be vigilant about providing adequate care for seafarer’s onboard ship. It is also important for crew members to remain attentive to the safety and well-being of their ship mates. If these concerns arise, offer help and support to the individual. Preventing suicides and mental health related accidents aboard ship is possible with proper policies and procedures in place and access to adequate care when incidents occur.

Caring for Seafarer’s Mental Wellbeing

Caring for Seafarers’ Mental Wellbeing is a document published in cooperation with the Seamen’s Church Institute (SCI), a renowned, US-based ministry to seafarers. The document provides guidance on responding to both routine and extreme stressors which affect the quality of life of mariners both ashore and afloat, and seeks to promote awareness generally of the importance of seafarer mental wellbeing. In addition, numerous maritime organizations have supported recent initiatives to enhance understanding about the emotional – and psychological – highs and lows of life at sea, and thousands of seafarers have shared their personal stories with SCI staff amid routine, stressful – or even tragic – circumstances. Accordingly, in augmentation of the guidance provided by the new document itself, the Club now maintains an up-to-date list of global mental health resources available to seafarers. This is intended to be a valuable resource to seafarers and others in providing access to mental health assistance as and when it might be required. Caring for Seafarers’ Mental Wellbeing can be found in English, new and traditional Mandarin, and Russian, along with the list of global mental health resources referred to above, at the Club website at:

https://www.american-club.com/page/seafarer-wellness

Hard copies in English of Caring for Seafarers’ Mental Wellbeing can be obtained from the Managers free of charge.

Caring for Seafarers’ Mental Wellbeing

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There are numerous outlets around the globe available to listen and support!

The American Club keeps an up to date listing of mental health resources available to seafarers at our website at:

https://www.american-club.com/files/files/mental_wellness_resources_October_2018.pdf

The Seamen’s Church Institute of New York and New Jersey

The Seamen’s Church Institute is a venerable seafarer’s ministry and welfare organization with offices and support services based in the Port of New York and New Jersey but provides services to mariners in major seaports and inland waterways in the United States. They are the only free legal aid program for seafarers worldwide. The Center for Seafarer’s Rights is the Seamen’s Church resource center for seafarers in need of any kind of assistance. Email csr@seamenschurch.org for any needs or assistance. Visit www.seamenschurch.org for complete information on pastoral care, legal aid, continuing maritime education. The Center for Seafarer’s Rights has a full staff of chaplains who engage with seafarers daily providing services during shore leave, including counseling and religious guidance for crewmembers that are in need.

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